Most patients with knee arthritis have it in both knees. One is usually worse. The question that follows is whether to do both together or one at a time, and the honest answer is that it depends far more on the patient than on the knees.

What doing both at once gives you

One anaesthetic, one hospital admission, one rehabilitation period, one block of time off work. Both legs are corrected together, which avoids the awkward months of walking on one new knee and one arthritic one. For patients with deformity in both knees, that matters more than it sounds.

For families travelling from outside Mumbai, it also collapses two trips into one.

What it costs you

More blood loss, a larger physiological hit, and no good leg to lean on in the first week. The published data shows a higher rate of cardiac and pulmonary complications and higher transfusion rates with both knees done under one anaesthetic compared with staging them, although the absolute numbers in carefully selected patients remain low.

That last phrase is doing the real work in that sentence. Selection is the whole argument.

Who is a reasonable candidate

Broadly, a patient under about 70 with good heart and lung function, controlled diabetes and blood pressure, a body weight that allows two legs to be rehabilitated at once, and support at home for the first fortnight. Severe deformity in both knees pushes in favour. Significant cardiac disease, poor lung function, obesity, or living alone push firmly against.

Staging the two operations by about six to twelve weeks is the compromise most patients end up with, and it is not a defeat. It is the safer default when any of the above is uncertain.

How to decide

Ask for a cardiac and anaesthetic opinion before you decide, not after. Ask who will be at home with you in week one. Then make the decision with those two answers in hand rather than on convenience alone.

Further reading: https://www.mayurajcc.com/knee-arthritis-guides/knee-arthritis-in-both-knees and https://www.mayurajcc.com/knee-replacement-guides/knee-replacement-recovery-timeline and https://www.mayurajcc.com/knee-replacement-guides/knee-replacement-risks-complications